Oregon was selected by the Centers for Medicare and Medicaid Services (CMS) as one of 14 regions across the country to implement
Comprehensive Primary Care Plus (CPC+).
CMS refers to CPC+ as the
"largest-ever multi-payer initiative to improve primary care in America." In January 2018, CMS opened up Round 2 of CPC+ for new CPC+ regions and additional payers in current CPC+ regions. Round 2 will run for four years, completing at the same time as CPC+ Round 1. Round 2 has resulted in four more CPC+ regions (for a total of 18) and three more participating Oregon payers (marked with an asterisk below), for a total of 19 participating Oregon payers.
CPC+ is a regionally based, multi-payer advanced medical home model offering an innovative payment structure to improve health care quality and delivery. It is a five-year federal program beginning in January 2017 that will bring significant Medicare dollars to Oregon.
Over 150 practices in Oregon have been selected to participate in CPC+. The practices are diverse and vary by size, organizational structure, geographic location and practice type. All participating practices will be required to be recognized as a
Patient-Centered Primary Care Home (PCPCH) by the Oregon Health Authority (OHA).
Sixty-five practices participated in the first
Comprehensive Primary Care initiative, bringing $12 million of additional funding paid directly to primary care practices. Oregon's more robust participation in CPC+ will bolster our efforts to move from fee-for-service to a system that pays for outcomes.
The Oregon CPC+ payers formed the
Oregon CPC+ Payers Group and meet monthly to:
- Collaborate to support sustainable primary care transformation that results in healthier patients and lower costs
- Identify and share payer and clinic best practices to achieve program care delivery and payment model goals
- Align to reduce fragmentation, seek simplification, and leverage existing resources
- Seek to understand and demonstrate the value of the model to change expectations of how primary care is funded
Oregon payers participating in CPC+
Oregon Health Authority fee-for service Medicaid
- Moda Health Plan, Inc.
- Providence Health Plan and Providence Health Assurance
Coordinated care organizations (CCOs)
- Advanced Health
- AllCare CCO, Inc.
- Columbia Pacific CCO
- Eastern Oregon CCO
- Health Share of Oregon (not a CPC+ payer, but represented by CareOregon and Providence, participating Health Share of Oregon payer partners)
- InterCommunity Health Network*
- Jackson Care Connect
- PacificSource Central Oregon
- PacificSource Columbia Gorge
- Trillium CCO*
- Willamette Valley Community Health Organization
- Yamhill Community Care Organization
*Joined CPC+ for Round 2, which began January 1, 2018, and will run for four years, completing at the same time as CPC+ Round 1.
OHA fee-for-service resources
Practice enrollment in OHP fee-for-service
Quality and utilization measurement
Patient list changes - upload all OHP members
While the Oregon Health Authority will only be issuing PMPM payments for fee-for-service (FFS) members,
please enroll all of your Oregon Health Plan members, regardless of if the member is FFS or enrolled in a CCO. We envision that this change will simplify your patient list creation processes. OHA will calculate two utilization measures for your practices to determine if you qualify for a Performance Incentive Payment. Given the small number of FFS members, OHA will calculate your performance based on all of your enrolled Oregon Health Plan members; however performance incentive payments will be issued as a PMPM payment only for FFS members. We anticipate that incentive payments will be available starting in Q4 2017.